The Achilles’ Heel of Joint Replacement: Compliance

By David Brown, CEO and Founder, VOX Telehealth

Beginning in 2012, the Hospital Readmissions Reduction Program was established in the Affordable Care Act, requiring Medicare to reduce payments to hospitals with relatively high patient readmission rates. It was designed to encourage hospitals to ensure patients are discharged with the knowledge and direction to help them on their road to recovery, and help them avoid returning to the hospital. In other words, it’s a “get out and stay out” program. Incentivizing Medicare reimbursement on six conditions, one of which is total joint replacements, the program is one step in the transition to value-based care.

Nearly five years later, readmission rates have dropped, but still more than half of all hospitals (nearly 2,600) face fines for higher-than-expected readmission rates. Next year, it’s anticipated that these readmission penalties will total more than $500 million.

So, how can hospitals that are still facing these challenges avoid these penalties in the future? In many cases, it comes down to the need for optimizing patient preparation and compliance.

An important step in avoiding readmission penalties is for hospitals to make the patient more accountable during their episode of care. For procedures resulting from trauma or other urgent care scenarios, this is easier said than done, but for elective procedures, it can be a seamless and efficient process that produces an immediate return. This is especially true for total joint replacement surgery because of its high volume and proven best practices that, if implemented and monitored, result in predictable, standardized outcomes.

When joint replacement patients fail to properly follow discharge instructions, outcomes and readmissions are frequently impacted negatively. Whether it’s caring for the wound, taking medication, performing the proper exercises or being present for follow-up appointments, total joint replacement patients need to be compliant with the care plan to reduce complications and avoid heading back to the hospital.

However, patient education without ongoing monitoring and accountability is not enough. Once a patient is discharged, it’s extremely difficult to make sure that the care plan is being followed. Discharge plans include a significant amount of instructions, precautions and milestones that must be adhered to. While the patient is rarely intentionally neglectful towards the plan, there are many ways a care plan could go awry, and it is certainly not efficient, or financially feasible, to dedicate the necessary human resources to drive the level of compliance required to keep patients on track.

Despite the challenges, a technology-enabled solution for patient management can go a long way towards fulfilling all of the education, coordination and accountability that is necessary for standardizing the outcomes of a patient population, and in turn enables clinical staff to focus on unavoidable complications and particularly non-compliant patients.

Patient Education

Proper patient education is fundamental for improved compliance. When a patient is prepared and knows exactly what to expect and what they should be doing, they will often follow the care plan. However, simply educating a patient during a pre-op tutorial, providing information at the time of discharge, and checking in on patients via scheduled follow-up calls is not enough.

Patient management technology solutions, like VOX OrthoCare, ideally begin with education and coordination 30 days in advance of a procedure with information on how to prepare for surgery. These programs should continue to monitor and engage the patient for 90 days post-surgery, ensuring that the patient experiences a seamless recovery.

The active learning style and knowledge assessments, monitored coordination tasks, and patient reported outcomes facilitate actionable knowledge and “ownership” of care by the patient and caregiver before and after their procedure.


Clear, effective communication is also extremely important for compliance. Not every patient is the same, nor is each care plan. With constant connectivity and active communication, the patients and the provider can stay in touch regarding their unique treatment plan to drive adherence. Patient management solutions enable such communication through a secure outlet to provide confidence for independent care, as well as a means for real-time intervention in the case of unavoidable complications.

Accountability and Reporting

When you know you’re being monitored, you are more likely to follow-through with what is expected of you. It’s human nature. Patients who know that their care team will be actively involved in reviewing their progress are more likely to be compliant with their care plan.

Patient management solutions provide an efficient and comprehensive means of patient monitoring. Solutions like VOX OrthoCare not only provide a “transparent window” into the compliance characteristics of every patient, but also employ a proprietary alert escalation and notification system that is driven by customizable protocols for all of the patient’s activities and observations. While this system of education and accountability optimizes actionable knowledge and activation on the part of the patient and caregiver, it correspondingly optimizes the work-flow and actions of the clinical staff, allowing each party to perform to their highest appropriate level

Compliance doesn’t have to be the “Achilles’ heel” of joint replacement. With a technology-enabled patient management solution, healthcare facilities can empower patients to be capable and accountable partners in their care.

About the Author

David Brown is the Chief Executive Officer and Founder of VOX Telehealth. He brings more than 20 years of entrepreneurial experience spanning several industries, including behavioral healthcare, technology, banking, and retail. Prior to founding VOX Telehealth, David spent 10 years overseeing patient engagement for a multi-state behavioral healthcare practice, and understands the importance of connectivity and programs that engage patients in a meaningful and effective way.

About VOX Telehealth

VOX Telehealth was founded to improve patient outcomes by redefining the patient experience and recovery model. Through a state-of-the art platform, VOX delivers procedure-specific, full episode-of-care engagement solutions that provide education, coordination, and monitoring through industry leading content, proprietary SmartTasks™ and a customizable alert escalation and notification system. Engaging the patient throughout their pre-op phase, as well as through transition of care and recovery, patients are connected and accountable, leading to greater satisfaction, improved outcomes, and reduced cost of care. For more information about VOX Telehealth and its orthopedic platform, the OrthoCare Program, please contact [email protected].

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